We know that behavior is a form of communication, and that inadequate communication skills and problem behavior go hand-in-hand. This holds true for typically-developing toddlers (just ask any parent!) and also for individuals with communication disabilities, who may have had years (or decades) to develop disruptive, destructive, or dangerous behavior patterns. These are tough students, and tough situations, but also can be some of the most rewarding— when we can help a client learn a new way to communicate what they could only say through behavior.

A well-known intervention for doing just this is Functional Communication Training—an approach where you study the behavior to learn its function (generally by doing a functional behavioral assessment, or FBA; you may call these ABCs or some other fun acronym), and systematically teach a new, more socially-acceptable way to communicate that message. Instead of head-banging to escape challenging academic tasks, maybe the student can ask for help or a break instead. Sounds obvious, but the trick is in getting everyone to recognize the communication behind the behaviors and follow through with prompting and reinforcing the replacement. This is why we advocate!

This new systematic review of FCT intervention studies specifically targeted situations where FCT was used in schools, with AAC in the mix. They found 17 studies that met the eligibility and quality guidelines. Subjects were school-aged and had a range of disabilities. Overall, FCT resulted in less problem behavior and more AAC use, with large effect sizes*. The authors found that larger effects were seen with less intense behavior, and that destructive behaviors may simply take more time to eliminate. They also noticed that FCT tended to be more effective in inclusive school settings (more integration with students without disabilities) and that interventions informed by descriptive, rather than experimental, FBAs had better results. This last point is interesting; less-rigorous FBAs carried out by regular school personnel may be as good, or better, in these situations than the type you might hire an outside specialist to perform.

A range of different specific strategies (how communication was prompted and reinforced, etc.) seemed to be effective, so a student-centered approach, where you develop the intervention protocol with the individual in mind, looks like the way to go. The authors also include some helpful references for readers who need specifics on implementing FCT.

*This is great, but remember publication bias. It’s less likely that someone would write up and publish a case study of an intervention that didn’t do anything.